A study recently published in BJOG investigates the extent of persistent urinary incontinence 12 years after childbirth. Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12–year longitudinal cohort study is a multi-institutional study including sites in Aberdeen and Birmingham, United Kingdom and Dunedin, New Zealand. The study included questionnaire data from women 3 months and 12 years after index birth. Of note, this was a follow up study to a previous 6-year investigation on the same subject (1). Of the 7879 women recruited at 3 months, 3763 (48%) responded at 12 years. The prevalence of persistent urinary incontinence (UI) was 37.9%. In other words, over one third of women had persistent UI 12 years after delivery. Subjects who reported UI at 3 months 76.4% reported UI at 12 years. The data suggests that UI persists to 12 years in about three-quarters of women.
Women who delivered exclusively by caesarean section (CS) were less likely to have persistent UI (OR 0.42, 95% CI 0.33 to 0.54). However there was no difference in women who had a combination of CS and vaginal delivery births (OR 1.01, 95% CI 0.78 to 1.30).
Previous studies showed no differences in protection from different types of caesarean section (2,3). The current study findings suggest that the risk of persistent UI in the long term was only reduced with caesarean section if women experienced no other mode of delivery. Women who underwent only caesarean section were half as likely to have persistent UI compared to those having vaginal births. Other factors such as older age at first birth, greater parity, and overweight/obesity were associated with persistent UI. Also, 85.2% of index first deliveries with UI before pregnancy had persistent UI 12 years later. A notable limitation of the study is that more than half of women were lost to follow up. However although attrition between 6 and 12 years is high, there was an over 70% response rate at 6 years.
More research on obstetric and other factors that may influence the risk of UI, and particularly on prediction and prevention measures to reduce this risk may help further quantify these associations and assist decision making approaches. Ultimately clinical decisions regarding mode of birth in regard to risk of urinary incontinence needs to be balanced against risks of caesarean section for the mother and baby.
Article by the Publications and Communications Committee
Urinary incontinence persisting after childbirth: extent, delivery history, and effects in a 12–year longitudinal cohort study
(1)MacArthur C, Glazener CMA, Wilson PD, Lancashire RJ, Herbison GP, Grant AM. Persistent urinary incontinence and delivery mode history: a six–year longitudinal study. BJOG 2006;113:218–24.
(2)Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 2012;120:144–51
(3)Boyles SH, Li H, Mori T, Osterweil P, Guise JM. Effect of mode of delivery on the incidence of urinary incontinence in primiparous women. Obstet Gynecol 2009;113:134–41.